ABSTRACT
Drawing parallels between personal and institutional psychic functioning, this chapter outlines the way in which institutions can become unconscious containers for societal anxieties. For example, in addition to its overt task of improving health, the healthcare system is looked to unconsciously to ‘keep death at bay’. Education systems are repositories of societal anxieties about who will succeed and survive, and who will fail. The anxieties projected into public sector services readily produce social defence systems that inhibit achieving the primary task, such as the paranoid-schizoid split between management and clinical practitioners, or the fantasy that with unlimited money, all illness could be cured. As resources shrink, anxieties increase and counterproductive defences like intergroup rivalry and us-and-them splitting increase. The chapter outlines various approaches to managing the work of the public sector more effectively, including clarity about task and authority, the opportunity for staff to participate and contribute, psychologically informed management, and a different kind of engagement with ‘consumers’ (the public). A key challenge is how to maintain enough of an outside perspective to retain a capacity for critical questioning, without excessive denial of the reality that our public sector institutions exist to help people cope with pain, unfulfilled hopes, sickness and death.
