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The walls within: working with defenses against otherness

Online Conference 5-11 July 2021

AM22-PP5: Organizational psychosis and the capacity to care

Parallel Papers Session 2
Friday 1 July 2.45pm-4:00pm (14.45-16.00) CEST
Paper Code: PP5
CE credits available

Organizational psychosis and the capacity to care

Presenter: Carrie M. Duncan


Inexplicable things happen inside organizations – absurdities, irrationalities, and repetitions. The magnitude of the unexplainable can range from minor acts of poor organizational citizenship to severe departure from ethics and the law that have global implications. This paper will examine one aspect of unexplainable phenomena in organizations – falling apart.

When teams, divisions, or whole organizations fall apart the metaphor of psychosis (Sievers, 1999) is a useful lens for understanding what is happening. It is also a useful lens for debriefing medical errors, ineffective responses to organizational crises (e.g. threats to funding), and organizational traumas (e.g. violence, death). In other words, by carefully examining the psychotic (primitive) defenses and ways of relating (if present) manifesting in organizational failures, we can learn what leader/manager failures have created them, and what “provisions” may prevent them in the future (see Winnicott, 1945).

The focus of this paper is caring organizations (e.g. hospitals, behavioral health organizations, and counseling practices) where the discontinuities and traumas inherent in the work of caring can precipitate organizational psychosis and collapse the capacity to care. An example of reactions to violence in caring organization is presented and analyzed for clues about why things sometimes fall apart at work, or don’t, and what organizational leaders can do to help people in the organization “gather together” (Ogden, 2004) the “bits and pieces” (p. 140) of their experiences and move forward in relative ‘health’. The alternative is to remain disintegrated (psychotic), which has negative implications for workplace culture and the work of caring for patients.

Disintegration is evidenced by a lack of orientation to time (e.g. no past and no future; Diamond & Allcorn, 2009), an inability to maintain boundaries between self and other (Diamond & Allcorn, 2009; Ogden, 1989), and a pervasive sense of disconnection (Winnicott, 1945). In a sense, people in the organization become “maddeningly oblivious” (Winnicott, 1945, p. 137) to one another, to the external environment, and to the possibilities of a productive future. This position may also be described as a collapse into the paranoid-schizoid positon (Klein 1946; 1948), away from the depressive and autistic-contiguous modes of experiencing (Diamond & Allcorn, 2009; Ogden, 1989).

Winnicott (1945) provides us with a clue about the origins of (organizational) psychosis in his paper on primitive emotional development, describing psychosis as a regression to an original “unintegrated” state in the face of anxiety. It is during this primary stage of development that good enough mothering and environmental supplies are needed for infants to develop integration, personalization, and realization (p. 139). In this paper I will elaborate how this framework can be used to conceptualize the modes of leading and managing needed to create healing spaces that allow organizational members to meaningfully integrate the past, present, and future (see Diamond & Allcorn, 2009), feel real, and fully engage in the change processes needed to meet the future.

Learning Objectives

After the session participants will be able to:

  1. recognize the features of organizational psychosis..
  2. recognize the link between trauma and organizational psychosis.
  3. apply the concept of psychosis to analyze organizational functioning.


Diamond, M., & Allcorn, S. (2009). Private selves in public organizations: The psychodynamics of organizational diagnosis and change. Springer.

Klein, M. (1946). Notes on some schizoid mechanisms. International Journal of Psycho-Analysis, 27, 99-110.

Klein, M. (1958). On the development of mental functioning. International Journal of Psycho-Analysis, 39, 84-90.

Ogden, T. H. (1989). The primitive edge of experience. Jason Aronson.

Ogden, T. H. (2004). On holding and containing, being and dreaming. The International Journal of Psychoanalysis, 85(6), 1349-1364.

Sievers, B. (1999). Psychotic organization as a metaphoric frame for the socioanalysis of organizational and interorganizational dynamics. Administration & Society, 31(5), 588-615.

Winnicott, D. W. (1945). Primitive emotional development. International Journal of Psycho-Analysis, 26, 137-143.

Biographic Summary

Carrie (Mindy) Duncan is the Director of the Center for Psychosocial Organization Studies in Columbia, Missouri. She has an MA in anthropology and a PhD in Public Affairs, both from the University of Missouri. Her research interests include the psychodynamics of organizational culture and change, nonprofit management, behavioral health organizations, aesthetics in organizations and entrepreneurship, and psychosocial research methods. Mindy has published in Organisational and Social Dynamics, Organization Studies, and Organization.