The Containment of Health Care Anxiety: We base our analysis of health care cultures on this fundamental interplay between the experience of pain, the containment of anxiety, and the formation of organizational cultures. This interplay was carefully and persuasively documented more than forty years ago by Isabel Menzies Lyth (1988), who wrote about ways in which nurses in an English hospital cope with the pain and anxiety that is inevitably associated with issues of health, illness, and injury—issues of life and death. Menzies noted how the hospital in which nurses worked helped to ameliorate pain and protect the nurses from anxiety. She suggested that a health care organization is primarily in the business of reducing pain and the attendant anxiety and that on a daily basis all other functions of the organization are secondary to this pain and anxiety-reduction function.
It is specifically the culture of the organization that serves as the primary vehicle for addressing the nurses’ anxiety and stress associated with ameliorating the pain. The culture of an organization is highly resistant to change precisely because it directly threatens the informal system that has been established in the organization to help those working in it to confront the anxiety and make sense of the pain inherent in health care.
Menzies Lyth’ observations have been reaffirmed in many other organizational settings. Anxiety and pain are to be found in most contemporary organizations and efforts to reduce this pain and anxiety are of prominent importance. Hospitals and other health care systems, however, may be particularly saturated with pain and anxiety, given the unique problems they confront. It was not coincidental that Izabel Menzies Lyth, in studying a health care institution, was among the first to identify pain and anxiety as central issues in organizational life.
Somehow a hospital, or any other institution that must address the issues of pain and that is inclined to evoke anxiety among its employees and customers, must discover or construct a culture that creates a context for the pain and contains the anxiety. At the same time this institution must addresses the realistic, daily needs of both its employees and customers. How exactly does pain and anxiety get addressed in organizations?
Menzies Lyth suggested that pain and anxiety are addressed through the social defense system, which is a pattern of interpersonal and group relationships that exists in the organization. Other organizational theorists and researchers similarly suggest that the rituals, routines, stories, and norms (implicit values) of the organization help members of the organization manage pain and anxiety inside the organization. Yet, these rituals, routines, stories and norms are not a random assortment of activities. Rather, they cluster together and form a single, coherent dimension of the organization. This single, coherent dimension is known as the culture (small “c”) of the organization.
Isabel Menzies Lyth proposed that health care workers create the culture of a health care institution to contain anxiety. These institutions are to be neutral containers with the ability to absorb anxiety. But what happens when the container is cracked or acts in ways that intensify pain and anxiety—as seems to be the case in contemporary health care? What happens when pain is introduced into this equation, as it must be when we are considering organizations that tend to people who are ill, injured or even dying.
