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Auestad (2011) reviews Menzies Lyth’s (1960) groundbreaking study of nurses in Britain. The author integrates the work of Jacques (1953) and Melanie Klein to describe Menzies Lyth’s conceptualization of institutions as a mechanism used by individuals to strengthen their defenses. Social defenses are viewed as external manifestations of individual and collective defenses against anxieties. Social structures play the dual role of providing a way to defend against anxiety and provide a source of emotional development (facilitating attachment). This means that changes in institutional structures represent a real threat of exposure to anxiety, a potential source of resistance to change. However, the defensive social structure can itself result in secondary anxiety; failure to provide for emotional growth by impeding attachment. External structures can have an effect of unconscious processes such that lack of attachment is transformed into a sense of scarcity, in this case a scarcity of relationships with patients (failure of attachment). Menzies Lyth moves the Kleinian notion of splitting into the social realm by recognizing that individuals must “swallow whole” an existing social defense structure, a violent act, a traumatic “enforcement” of splitting. The author calls into question the lack of attention given to the “conflict of interest” between the nurses and their superiors. Menzies Lyth (1960) assumes a task orientation that is shared equally by the superiors and subordinates. “The notion that one may aim at changing one’s environment rather than adapting to it is absent from the account as is an idea of political agency” (pg. 408).

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