Organizational schism: Looking after a psychiatric service

What is opposed to psychoanalysis is not psychiatry but psychiatrists. (Freud, 1916–1917, p. 254) The defence that schism affords against the development-threatening idea can be seen in the operation of schismatic groups, ostensibly opposed but in fact promoting the same end. (Bion, 1961, p. 159) This paper deals with group dynamics, not about therapeutic groups, but about professional groups. Mental health workers labour in a setting of high stress. One of the forces that affect groups under stress is that they can divide into two, which often exist in mutual opposition: Psychodynamic psychotherapy itself has never been free of oppositional relations with other groups. We need a framework for thinking about the schisms that we are a part of, on the one hand with orthodox psychiatry and psychiatrists, and on the other, with psychologists and CBT. This paper will attempt to look at the stress of uncertainty and the stress of risk management, stresses which arise from the work, and emerge as interdisciplinary feuds.