ABSTRACT
Isabel Menzies Lyth's landmark account of a nursing service, "A Case Study in the Functioning of Social Systems as a Defence against Anxiety", is well known, and it contains a fundamental truth that seems to elicit instant recognition from every kind of reader. Although she describes the social defence as a protection for nurses against the impact of the nursing task, the stress and anxiety that it created in them was far from protective. The correlation between the defensive nursing techniques and obsessional mechanisms with their punitive superego falls readily into place, as if what we might name as an obsessional–punitive social defence was exactly what Menzies Lyth had in mind. Psychoanalytic theory in the Freud–Klein model tells us that at the threshold of the depressive position the cognitive integration of a whole object is in advance of emotional integration and that obsessional–punitive defences are used to control unintegrated aggression.
