Public anxiety and health policy: A psychodynamic perspective

In this article, we explore how the application of organizational psychodynamic theories might improve the understanding of unconscious forces influencing apparently rational and evidence-based processes such as the generation and implementation of health policy. There is a growing body of literature using psychodynamic theories to explore discontinuities in policy-making and the containment of anxiety in organizations. In this article, we focus on the dyadic relationship between policy formation and the media/public response, in particular knee-jerk reactions that can cause ‘U’ turns in policy implementation, and the role of organizational leaders in containing public anxiety. We illustrate this using three contrasting instrumental case examples. Drawing on the seminal work of Isabel Menzies and the psychodynamic literature, we explore how anxiety is manifested in organizations and the role of public institutions as receptacles of public anxiety. We suggest that policy has a latent function of controlling objects into which public anxiety is projected and that we need to understand the sources of this anxiety if more rational policy responses are to ensue. We also explore the implications this has for policy development generally and for the role of senior managers.