Beautiful Minds

‍Michael: The response to whistleblowers - shooting the messenger - is about what happens when people find that their “not-knowing” is challenged. One of the responses in the NHS is to become forceful in blocking unwelcome knowledge. 

David: The experiences that nurses have on the ward is fundamentally counter to the motivation for entering nursing in the first place which is caring for ill and vulnerable people. 

Michael: As welfare systems themselves become persecutory people now feel not simply that there’s a problem of how do I cope with the patients but how do I cope with the authorities that are supposed to be managing care. 

David: These defences don't work at the end of the day. They give rise to anxiety themselves. Our defences make things worse. 

To listen to the full conversation between David & Michael go here.

Two of the great thinkers in the Tavistock Tradition of finding meaning in organisations are David Armstrong and Michael Rustin. In their edited book Social Defences Against Anxiety they, along with another psychoanalytic great William Halton (oh how toe curling he’d find that description) invite us to understand the shadows of our working lives.  One of the most powerful ways of understanding the pressures of working in the care sector is their psychoanalytic framework of our defences against experiencing anxiety at work. A spicey trilogy of task related anxiety (anxiety about the work itself), persecutory anxiety (anxiety about the systems of performance management and their consequences) and an existential anxiety (the 3am sweat-soaked question of how far away from actually caring our systems of care have now become).

In their calm kind and modest way, these psychoanalytic thinkers offer an articulation of a reality that even in this shredded-ventral-vagus-post-Covid age most of us fail to be brave enough to see. A confident generation of new thinking, both radical and traditional in their belief that by understanding the dynamic underbelly of being in groups we might be able to influence the trajectory of care, both in our working and social lives.

In a time of relative optimism I wrote a book Surviving Work in Healthcare with the now naïve but hopeful sense that help could be given and received in our already failing services. As an organizing tool around the themes of the book I curated a series of discussions with psychoanalysts, academics and trade unionists about the underbelly of working in healthcare – free to view here. An invitation to explore bullying, racism and existential anxiety was surprisingly welcome by the old guard, and I am grateful for exposure to the radicalism that built the Tavistock Tradition and their support in opening up debates on the frontline.

I wonder now what they would have said about the quiet murder in the merger of the Tavistock with a London NHS Trust just a few weeks ago. An effortless loss of a site of genuine and deep expertise about the nature of care in our society.

David Armstrong was disarming. A radical mind dressed in a suit and tie, even at a dream matrix or taking a coffee round Belsize Park. A slight man with a powerful punch of intellectual precision and a deep and generous invitation to care deeply about our experiences of work, precisely during the period where attrition and silencing started to rule. As a driver of psychoanalytic ideas within organisational consultancy, I always felt he had made the smartest move, which was to understand that the power of psychoanalysis was likely to be understood more profoundly outside of the institutions of psychotherapy. That as the NHS architecture becomes designed around attrition and un-care we might only understand psychoanalysis in groups and organisations where the ability to understand dynamics are potentially life saving.

I regret that I didn’t get the chance to make David read my new book UberTherapy and ask him to think about why we might prefer an AI Analyst, and what we might do about the defence of deep work. As a radical mind, I think he would have been interested enough about the future of psychoanalysis to see it as something to do with him.

On the  2 May 2026 David Armstrong died. He and his beautiful mind are already greatly missed.

To hear the full conversation between Michael Rustin, David Armstrong and Elizabeth Cotton go here. 

To read Elizabeth Cotton’s book Surviving Work: Helpful stuff for people on the frontline go here.

On the 26th June 6.30-8pm BST Andrew Samuels, Linda Michaels and Elizabeth Cotton will discuss the new book UberTherapy: The New Business of Mental Healthand the politics of digital therapy in the face of widespread platformization. The event will challenge participants to raise their consciousness and consider a defence of deep work and the what next in the story of UberTherapy.   

Reserve your tickets for the book launch of UberTherapy here.