Good Enough

I’m about to get all pan-sexual on you by pointing out nothing ever gets created in isolation. Yup, intercourse. Embarrassing but true, that any creative process involves the pain and frustration of trying to get it on with other people and the intrinsic anxieties of rejection. Babies, books and book-babies, you’re never sure what will come out of it.


I’m now going to be rude about my publisher. When I got a copy of my book Surviving Work in Healthcare, I cried. In all honesty, this is an ugly bolshy teenager of a book. A front cover that evades an internal reality, major design faults and an angry rawness that you wouldn’t want to take on a family holiday.


Even in the dark dusty circles of academic publishing, economics has taken a toll. Mega corporations, long unmanaged subcontractor chains and unrealistic targets. I guess for a book about healthcare there’s a poetry in the fact that the publishing process reflects the neoliberal systems that make it really hard to deliver public service. In the words of the poor young rep sent out to stop me pulping the lot “it’s an ugly baby my babber”.


As random as life often is, in that one small sentence the book-baby was saved. A shared West Country vocabulary and childhoods spent loafing around Swindon meant that in ten minutes we’d laughed, cried (me) and agreed to cut the price by 50%. Finally, a good-enough relationship within which to bring up our ugly book-baby.


Probably the most common survival strategy at work is to withdraw from the people around us. Lunch breaks in the car park, flu on the exact day of the Xmas party and a pressing need for filing every time there’s a staff meeting.


To admit that major relationship dysfunction is an inevitable part of working life is not the politics of defeat, rather the belief that working life is about overriding our deep desires to lock ourselves in the toilets and trying to make the best of a bad lot. I regret that this process is not for the faint hearted because there is no psychic Ketamine to escape looking at some grim realities of human relationships. However, the proposal of Surviving Work in Healthcare is that it is through our relationships that we can ultimately build our capacities to survive work over the long term offering an alternative to the short-termist defences and wellbeing techniques that most of us fall into.


These are depressing times for anyone interested in having relationships at work, because we are facing a period of loss and insecurity probably the two most demotivating factors in workplace romance. Stress puts you right off other people. However, it is important not to get carried away with the sense of liquid fear that pervades healthcare. Precarity is not happening to the same degree at the same time everywhere, rather there are still opportunities for people to negotiate better working conditions and relationships. The fact is most of us still have contracts of employment, unions exist as do the institutions that we need to negotiate with. The system has not totally broken down, yet, but to do anything at all requires taking collectivity seriously.


Relationality, from a psychoanalytic perspective, is premised on our developmental reliance on our relationships for survival and shaping our identities. In this psychoanalytic model, infant development hinges on our attachments to the people around us. Although defences against the hell of other people are important, long term retreating from other people has consequences.


John Steiner’s book Psychic Retreats beautifully explores the defensive formation of mental bunkers that both protect us from perceived threats but also cut us off from reality and other people. Steiner describes this internal order as a mafia-like structure that re-establishes a sense of security by providing an internal organisation. Like the real mafia, it operates in an economy of threats (don’t you dare question the order) and the offer of protection (if you accept the order then you will be safe). People get stuck in their withdrawal even when its really not good for them.


Psychoanalytic ideas promote a model of development which is about taking a view of the world that is not black and white. Growth involves a psychologic process of moving away from a perspective where people like me are good and people who are not like me are bad, towards a more depressive position that we are all a mixture of good and bad aspects. This more balanced perspective about the world allows us to reduce the very human default position to project our angry and negative emotions into other people. The argument is that by accepting we are all able to hate and love we can then take some kind of ownership of the destructive emotions we all have to deal with in working life and get on with trying to work together. Hardly the stuff of romance but paving the way to ‘good-enough’ relationships.


Another positive effect of encouraging people to talk to you and each other is that we are often surprised at how smart and funny the people we work with actually are. Most of us whizz around in a blur of busy, and have forgotten how to be nice to each other and why that might feel nice. It is always in my experience surprisingly reassuring and humanising to hear what other people have to say.


In a way this book-baby Surviving Work in Healthcare has taken a lifetime to write because it draws on my experience of working as a trade unionist, an educator and as a psychotherapist, all of it dependent on my relationships with other people. Although its nice to think that books get written by a genius (me) who has simply brilliant ideas, as anyone who has ever created anything knows, it takes all of us to bring something to life.


So, to the thousands of people working in healthcare that I have met both in the flesh and virtually since setting up Surviving Work, I would be happy for every single one of you to run the NHS.


In 2016 I carried out a national survey of working conditions of mental health workers in the UK, the results of which will be published this year. To the 1500 people working in mental health who took part and talked me through the dilemmas they face every day. Thank you.


Each chapter starts with an extract from conversations with thinkers and practitioners in healthcare. In 2015 I carried out a series of conversations in partnership with the Tavistock & Portman NHS Trust to develop free materials using psychoanalytic ideas on how to improve working life To the people who gave their time to have these conversations, wow. Just wow.


For the thoughts and ideas you sent in response to the Surviving Work blogs over the years. Thank you. To the psychosocial academics and researchers who reminded me that actual facts matter. Thank you. To the folk who came to our survival events and courses and allowed yourselves to go through the pain threshold of free association on issues that actually matter. Thank you.


Despite the profound societal attack on our compassionate hearts, I have been overwhelmed by your love and respect for your patients, and the shear bravery many of you show just by turning up at work each day.


Surviving Work in Healthcare is a teenager so isn’t capable of actually saying THANK YOU but it is with enormous gratitude I can say that what we’ve created is really good enough.



Surviving Work in Healthcare: Helpful stuff for people on the frontline has been published by Routledge. Click here quoting code SUR230 to buy a copy for £17.50.



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