Human Relations

, Volume 52, Issue 6, pp 775–804 | Cite as

Psychiatric Services: Organizing Impossibility

  • Lynette Willshire


This paper explores the proposition thatelements of the work of psychiatric services areimpossible. The notion of impossibility is consideredfrom three perspectives: societal, interpersonal, andorganizational.Organizational elements of impossibility areevidenced in attempts to work with madness, a phenomenonthat defies clear definition. Resultant confusion inrole and task boundaries is exacerbated by madinterpersonal interactions. The situation iscompounded by societal conflicts between the mad and thesane. Attempts to house and treat the mad over the past200 years are reviewed, and recent illustrativecase material is presented from two communitytreatment teams. It is argued that primarilysolution-focused approaches to madness have limitedsuccess. To acknowledge impossible elements of the workmay enable psychiatric institutions to be designedin ways that help make individual and collective madnessmore bearable rather than something to be controlled andor denied.

madness psychiatry impossibility organization dynamics 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. ABBOTT, M. Key areas for rehabilitation in mental health. Mental Health in Australia, Dec. 1986, 17-25.Google Scholar
  2. ADELSON, M. J. Clinical supervision of therapists with difficult-to-treat patients. Bulletin of the Menninger Clinic, 1995, 59, 32-52.Google Scholar
  3. ANDREWS, G. A methodology for preparing “ideal” treatment outlines in psychiatry. Australian and New Zealand Journal of Psychiatry, 1982, 16, 153-158.Google Scholar
  4. ANTHONY, W.A., COHEN, M., & FARKAS, M. A psychiatric rehabilitation treatment program: Can I recognize one if I see one? Community Mental Health Journal, 1982, 18, 83-96.Google Scholar
  5. BACHRACH, L. L. Continuity of care for chronic mental patients: A conceptual analysis. American Journal of Psychiatry, 1981, 138, 1449-1456.Google Scholar
  6. BACKLAR, P. Health care re form: Will the subject fall out of the topic? Community Mental Health Journal, 1995, 31, 297-301.Google Scholar
  7. BATESON, G., JACKSON, D., HALEY, J., & WEAKLAND, J. Towards a theory of schizophrenia. Behavioral Science, 1956, 1, 251-64.Google Scholar
  8. BELLACK, A. S., & MUESER, K. T. A comprehensive treatment program for schizophrenia and chronic mental illness. Community Mental Health Journal, 1986, 22, 175-189.Google Scholar
  9. BETTELHEIM, B. A home for the heart. London: Thames and Hudson, 1974.Google Scholar
  10. BION, W. R. Second thoughts. London: Maresfield Library, 1984.Google Scholar
  11. BION, W. R. Experiences in groups, and other papers. Tavistock and New York: Basic Books, 1961.Google Scholar
  12. BION, W. R. Learning from experience. London: Maresfield Library, 1962.Google Scholar
  13. BOTT, E. Hospital and society. British Journal of Medical Psychology, 1976, 49, 97-140.Google Scholar
  14. BOTT SPILLIUS, E. Asylum and society. In Trist, E., & Murray, H. The social engagement of social science. London: Free Association Books, 1990.Google Scholar
  15. BOTT SPILLIUS, E. Personal communication, 1994.Google Scholar
  16. BRODY, E. B. The new biological determinism in socio-cultural context. Australian and New Zealand Journal of Psychiatry, 1990, 24, 464-469.Google Scholar
  17. CHOWANEC, G. D. Continuous quality improvement. Conceptual foundations and application to mental health care. Hospital and Community Psychiatry, 1994, 45, 789-793.Google Scholar
  18. COUSENS, P., & CRAWFORD, J. Moving the mentally ill into the community: The problem of acceptance and the effect of contact. Australian Journal of Social Issues, 1988, 23, 196-207.Google Scholar
  19. DIAMOND, R. J. Some thoughts on: “Around-the-clock mobile psychiatric crisis intervention.” Community Mental Health Journal. 1995, 31, 189-190.Google Scholar
  20. EISEN, P. A national mental health services report. Canberra: Department of Community Services and Health, 1988.Google Scholar
  21. EISENBERG, L. Health care: For patients or for profits? The Americal Journal of Psychiatry, 1986, 143, 1015-1019.Google Scholar
  22. ELLIOT, R. L. Applying quality improvement principles and techniques in public mental health systems. Hospital and Community Psychiatry, 1994, 45, 439-444.Google Scholar
  23. ELLIS, A. Reason and emotion in psychotherapy. New York: Lyle Stuart, 1962.Google Scholar
  24. ERRINGTON, M. The operation of the mental health act, 1983 (NSW). Australian and New Zealand Journal of Psychiatry, 1986, 20, 278-292.Google Scholar
  25. FINEMAN, S. Emotion and management learning. Management Learning, 1997, 28, 13-26.Google Scholar
  26. FISHER, W. H., GELLER, J. L., & WIRTH-CAUCHON, J. Empirically assessing the impact of mobile crisis capacity on state hospital admissions. Community Mental Health Journal, 1990, 26, 245-253.Google Scholar
  27. FREUD, S. Psychoanalytic notes on an autobiographical account of a case of paranoia. (Schreber) In Case histories II. The Pelican Freud Library (Vol. 9). Middlesex: Penguin Books Ltd. 1979.Google Scholar
  28. FREUD, S. On Narcissism: An introduction. In On metapsychology: The theory of psychoanalysis. The Pelican Freud Library (Vol. 11). Middlesex: Penguin Books. Ltd., 1984.Google Scholar
  29. FROMM-REICHMANN, F. Psychoanalysis and psychotherapy. Selected papers. Chicago: University of Chicago Press, 1974.Google Scholar
  30. GABBARD, G. O. Splitting in hospital treatment. American Journal of Psychiatry, 1989, 146, 444-451.Google Scholar
  31. GELLER, J. L., FISHER, W. H., & McDERMEIT, M. A national survey of mobile crisis services and their evaluation. Psychiatric Services, 1995, 46, 893-897.Google Scholar
  32. GOFFMAN, E. The insanity of place. Psychiatry, 1969, 32, 357-388.Google Scholar
  33. GOFFMAN, E. Asylums. New York: Anchor Books, 1961.Google Scholar
  34. GOLD, S. Projective identification: The container and reverie as concepts in applied psychoanalysis. British Journal of Medical Psychology, 1983, 56, 279-285.Google Scholar
  35. GOLD, S. The sterile organization. Australian and New Zealand Journal of Psychiatry, 1995, 29, 370-373.Google Scholar
  36. GORDON, E., BARRY, R. J., ANDERSON, J., FAWDRY, R., YONG, C., GRUNEWALD, S., & MEARES, R. A. Single photon emission computed tomography (SPECT) me asures of brain function in schizophrenia. Australian and New Zealand Journal of Psychiatry, 1994, 28, 446-452.Google Scholar
  37. HAMBRIDGE, J., & ROSEN, A. Assertive community treatment for the seriously mentally ill in suburban Sydney: A programme description and evaluation. Australian and New Zealand Journal of Psychiatry, 1994, 28, 438-445.Google Scholar
  38. HANDY, J. Stress and contradiction in psychiatric nursing. Human Relations, 1991, 44, 39-53.Google Scholar
  39. HIRSCHHORN, L. The workplace within. Psychodynamics of organizational life. Cambridge, MA: The MIT Press, 1988.Google Scholar
  40. HIRSCHHORN, L., & GILMORE, T. The new boundaries of the ‘boundaryless’ company. Harvard Business Review, May-June 1992, 104-115.Google Scholar
  41. HOPFL, H., & LINSTEAD, S. Introduction. Learning to feel and feeling to learn: Emotion and learning in organizations. Management Learning, 1997, 28, 5-12.Google Scholar
  42. HOULT, J., REYNOLDS, I., & CHARBONNEAU-POWIS, M. Psychiatric hospital versus community treatment: The results of a randomised trial. Australian and New Zealand Journal of Psychiatry, 1983, 17, 50-56.Google Scholar
  43. HOULT, J., ROSEN, A., & REYNOLDS, I. Community oriented treatment compare d to psychiatric hospital oriented treatment—. Social Science and Medicine, 1984, 18, 1005-1010.Google Scholar
  44. JACOB, K. S. The use of multiple psychotropic medication in the treatment of mental disorders. Australian and New Zealand Journal of Psychiatry, 1995, 29, 186-188.Google Scholar
  45. KENT, J. The Practice Group. Paper presented at the Australian Association of Group Psychotherapy Conference, Adelaide, July 1995.Google Scholar
  46. KLEIN, M. Notes on some schizoid mechanisms. In Klein, M., Heimann, P., Isaacs, S., and Riviere, J. (Eds.), Developments in psychoanalysis. London: Karnac Books, 1989.Google Scholar
  47. LAMB, H. R., & SHANER, R. When there are almost no state hospital beds left. Hospital and Community Psychiatry,1993, 44, 973-976.Google Scholar
  48. LAING, R. D. The divided self. Middlesex, England: Penguin Books, 1959.Google Scholar
  49. LAING, R. D. The politics of experience and the bird of paradise. Middlesex, England: Penguin Books, 1967.Google Scholar
  50. LAWRENCE, G. Management development. Some ideals, images and realities. In A. D. Colman and M. H. Geller (Eds.), Group relations reader 2. Washington, D.C.: A.K. Rice Institute Series, 1977.Google Scholar
  51. LEONARD, D. The state of public psychiatry. Australian and New Zealand Journal of Psychiatry, 1994, 28, 371-374.Google Scholar
  52. LIPOWSKI, Z. J. The integrative approach to psychiatry. Australian and New Zealan d Journal of Psychiatry, 1990, 24, 470-474.Google Scholar
  53. LOMAX, M. The experiences of an asylum doctor. London: George Allen & Unwin, Ltd, 1921.Google Scholar
  54. MAIN, T. The ailment. British Journal of Medical Psychology, 1957, 30, 129-151.Google Scholar
  55. MAUDSLEY, H. Natural causes and supernatural seemings. London: Watts & Co., 1886.Google Scholar
  56. MAUDSLEY, H. F. Whither psychiatry? Lecture II. The Medical Journal of Australia, Apr. 1950, 521.Google Scholar
  57. MENZIES LYTH, I. The development of the self in children in institutions. In Containing anxiety in institutions. London: Free Association Books, 1988.Google Scholar
  58. MENZIES LYTH, I. The dynamics of the social. London: Free Association Books, 1989.Google Scholar
  59. MILLER, E. J. From dependency to autonomy. Studies in organization and change. London: Free Association Books, 1993.Google Scholar
  60. MILLER, E. J., & RICE, A. K. Selections from systems of organization. In A. D. Colman and W. H. Bexton (Eds.), Group relations reader 1. Washington, D.C.: A.K. Rice Institute, 1967.Google Scholar
  61. MORSTYN, R. Some fallacies of statistical inferences about psychotherapy. Australian and New Zealand Journal of Psychiatry, 1993, 27, 101-107.Google Scholar
  62. MOYLAN, D. The dangers of contagion: projective identification processes in institutions. In A. Obholzer and V. Z. Roberts (Eds.),. The unconscious at work. London and New York: Routledge, 1994.Google Scholar
  63. MUNDT, C., & SPITZER, M. History of philosophy of mind and mental disorder. Current Opinion in Psychiatry, 1993, 6, 704-708.Google Scholar
  64. MUNETZ, M. R., & GELLER, J. L. The least restrictive alternative in the postinstitutional era. Hospital and Community Psychiatry, 1993, 44, 967-973.Google Scholar
  65. NEWTON, J. The Implementation of Case Management in a Correctional Institution. Presentation at Research Colloquium, Swinburne Graduate School of Management, September 1998.Google Scholar
  66. OBHOLZER, A., & ROBERTS, V. Z. (Eds.). The unconscious at work. London and New York: Routledge, 1994.Google Scholar
  67. PARRY-JONES, W. L. The trade in lunacy. London: Routledge & Kegan Paul, 1972.Google Scholar
  68. PORTER, R. Mind-forg'd manacles. London: Penguin Books, 1990.Google Scholar
  69. RHODES, L. Emptying beds: The work of an emergency psychiatric unit. Berkeley: University of California Press, 1991.Google Scholar
  70. RICCI, W. F. Self and intersubjectivity in the supervisory process. Bulletin of the Menninger Clinic, 1995, 59, 53-68.Google Scholar
  71. ROBERTS, V. Z. Conflict and collaboration: managing intergroup relations. In A. Obholzer and V. Z. Roberts (Eds.), The unconscious at work. London and New York: Routledge, 1994.Google Scholar
  72. SCULL, A. Museums of madness. The social organization of insanity in nineteenth-century England. Middlesex, U.K.: Penguin Books, 1982.Google Scholar
  73. SHAKESPEARE, W. Hamlet. New York and Toronto: The New American Library, 1963.Google Scholar
  74. SHAPIRO, E. R., & CARR, A. W. Lost in familiar places. Creating new connections between individual and society. New Haven: Yale University Press, 1991.Google Scholar
  75. SHEA, B. An Overview of Psychiatric Rehabilitation in Australia. Proceedings of the First National Conference on Psychiatric Rehabilitation. Redfern, New South Wales, March 12-13, 1982.Google Scholar
  76. SILOVE, D. Biologism in psychiatry. Australian and New Zealand Journal of Psychiatry, 1990, 24, 461-463.Google Scholar
  77. SLATTERY, J. P. Report of the Royal Commission into deep sleep therapy. (Vol. 1). Australia: Government Printing Service, 1990.Google Scholar
  78. SNOWDON, J. Key Issues in Psychiatric Rehabilitation. Proceedings of the First National Conference on Psychiatric Rehabilitation. Redfern, New South Wales, March 12-13, 1982.Google Scholar
  79. STANTON, A. H., & SCHWARTZ, M. S. The mental hospital. A study of institutional participation in psychiatric illness and treatment. London: Tavistock Publications Limited, 1954.Google Scholar
  80. STEIN, L. I., & TEST, M. A. An alternative to mental hospital treatment. I: Conceptual model, treatment program and clinical evaluation. Archives of General Psychiatry, 1980, 38, 392-397.Google Scholar
  81. STOKES, J. Institutional chaos and personal stress. In A. Obholzer, and V. Z. Roberts (Eds.), The unconscious at work. London and New York: Routledge, 1994.Google Scholar
  82. STOLLER, A., & ARSCOTT, K. W. Report on Mental Health Facilities and Needs of Australia. Canberra: Government of the Commonwealth, 1955.Google Scholar
  83. TALBOTT, J. A. The patient: First or last? Hospital and Community Psychiatry, 1984, 35, 341-344.Google Scholar
  84. TEST, M. A., & STEIN, L. I. Practical guidelines for the community treatment of markedly impaired patients. Community Mental Health Journal,1976, 12, 72-82.Google Scholar
  85. TORREY, E. F. Does psychiatry have a future? In J. P. Brady and H. K. H. Brodie (Eds.), Psychiatry at the crossroads. Philadelphia, PA: W. B. Saunders & Co., 1980.Google Scholar
  86. TOWELL, D., & HARRIES, C. Innovation in patient care. An action research study of change in a psychiatric hospital. London: Croom Helm, 1979.Google Scholar
  87. WARNER, R. Recovery from schizophrenia. London and New York: Routledge, 1994.Google Scholar
  88. WILLIAMS, J. F. Present-day trends in psychiatry. The Medical Journal of Australia, Oct. 25, 1947, 505-512.Google Scholar
  89. WINNICOTT, D. W. The theory of the parent-infant relationship. International Journal of Psycho-Analysis, 1960, 4, 585-95.Google Scholar
  90. WINNICOTT, D. W. Playing and reality. London: Tavistock Publications Ltd., 1971.Google Scholar
  91. ZEALBERG, J. J., SANTOS, A. B., & FISHER, R. K. Benefits of mobile crisis programs. Hospital and Community Psychiatry, 1993, 44, 16-17.Google Scholar

Copyright information

© The Tavistock Institute 1999

Authors and Affiliations

  • Lynette Willshire
    • 1
  1. 1.Swinburne University of TechnologyHawthorn, VictoriaAustralia

Personalised recommendations