Containing Anxieties in Institutions or Creating Anxiety in Institutions: A Critique of the Menzies Lyth Hypothesis

Abstract

The Isabel Menzies Lyth hypothesis posits that the organization of the hospital is constructed so as to defend nurses from their psychotic anxieties. Institutional arrangements allow a “rational madness” which is beyond reform, because reform might lead to a deconstruction of the institutions. I argue, alternatively, that the institution has been organized in the interests of its owners and/or managers, the result of which is to exacerbate nurses' anxieties. Corporate/Taylorist approaches exacerbate fragmentation and encourage primitive defenses. A non-corporate/Taylorist organization would be conducive to less regressive psychological functioning and would stir up less anxiety, albeit at the expense of corporate-managerial control.